Visits to the office during 2012-2013 by children with a primary diagnosis of ADHD averaged 6.1 million per year, equivalent to a rate of 105 per 1,000 children aged 4 to 17 years, according to a large federal survey.
Most of these visits were not performed by a psychiatrist: 48% were performed by pediatricians and 12% by family doctors. Only a little more than a third of the visits (36%) were with psychiatrists.
The rate was especially high among children: 147 per 1,000 population, according to data from the National Survey of Outpatient Medical Care 2012-2013, reported in a data center of the National Center for Health Statistics.
Girls had less than half that rate, at 62 per 1,000, according to researchers led by Michael Albert, MD, MPH, CDC.
These disparities persisted when broken down by age group: for children aged 4 to 12, there were 156 visits per 1,000 children, compared to 59 visits per 1,000 girls and for children aged 13 to 17, visits for every 1,000 Girls.
Jeff Epstein, director of the Center for ADHD at the Cincinnati Children’s Hospital in Ohio, who was not involved in the study, said the disparity may be due to the fact that boys with ADHD tend to exhibit behaviors such as impulsivity, more likely to be referred for evaluation and treatment. “In contrast,” girls with ADHD are more likely to have problems with inattention. ”
The low rate of psychiatric participation can be attributed to the uneven distribution of specialists across the country, Epstein suggested.
“In many regions of the United States, especially in rural areas, access to mental health specialists is often reduced … Even in areas where mental health specialists, such as psychiatrists, often can support it. Therefore, many children with ADHD rely on primary care pediatricians for ADHD care. ”
Using CIE diagnostic codes, researchers determined that about 29% of children who had ADHD office visits had any additional mental health disorder, including episodic mood disorder (7%); anxiety, dissociative and somatoform disorder (7%); and disturbance of the specific emotions of childhood and adolescence (4%).
Thomas Power, of the Children’s Hospital of Philadelphia, who also did not participate in the study, said that this is probably an understatement, since most ADHD visits are not with psychiatrists, “who are more accustomed to investigating other health comorbidities Mental. ”
When considering the use of CNS stimulant drugs, they found that these drugs were mentioned – whether given, prescribed or continued – in 80% of all visits.
The most commonly mentioned were 47% methylphenidate (Ritalin, Concerta, Daytrana) or dexmethylphenidate (Focalin), followed by 13% amphetamine / dextroamphetamine combinations.
Power noted that CNS medications are commonly prescribed because “ADHD symptoms have been shown repeatedly in children and adults. In general, about 75-80% of children will respond to one or both of the stimulant classes mentioned in Article. ”
He noted that the disparity in use of the two classes of medications, methylphenidate and amphetamines, “is most likely the result of prescription patterns embedded between doctors and marketing and does not reflect differences in efficacy.”
If these drugs are not effective, doctors will use second-line drugs such as Atomoxetine (Strattera), Power said, adding that non-pharmacological treatments such as behavioral therapy “may be used in combination with pharmacological treatments and even alone in milder cases ADHD. “